Stephanie K Grutzmacher

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Scholarly Contributions

Chapters

• Wilson, H., Grutzmacher, S. K., Parlin, J. M., McCullough, L., & McNair, L. (2024). Creating Partnerships in Your Community. In Culinary Medicine(pp Chapter 11). Tucson: University of Arizona.

Journals/Publications

• Kilgrow, J., Gamble, E., Meier, A., Lyman, K., Barney, A., Kartchner, C., Martinez, P., Lee, K., Mathusek, C., Ang, K., Green, B. M., Banna, J., Eggett, D. L., Grutzmacher, S. K., Jackson, J. A., OoNorasak, K., Stokes, N., & Richards, R. (2025). Development, validation, and reliability testing of the College Perspectives Around Food Insecurity survey. . PLOS ONE, 20(1), e0317444. doi:10.1371/journal.pone.0317444
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  The objective of this study was to develop and to test the validity and reliability of a surveyaimed to evaluate internal and external factors associated with college food insecurity.Researchers used a mixed methods approach to evaluate the College Perspectivesaround Food Insecurity survey. Survey items were constructed from interview data andassigned a social cognitive theory concept (environment, personal, or behavior). Tworounds of expert reviews established content validity (Round 1, n = 3; Round 2, n = 2).Researchers evaluated face validity through two rounds of cognitive interviews with col-lege students 18+ years old (Round 1, n = 9; Round 2, n = 16) and tested survey reliabil-ity (n = 105). Researchers used descriptive statistics, test-retest reliability statistics, andCronbach’s alpha scores for data analysis. The initial survey contained 143 items. Afterfeedback from expert reviewers and cognitive interviews, the final survey contained 99items. Test-retest reliability was 0.99, and Cronbach’s alpha scores were 0.74 for environ-ment, 0.47 for personal, and 0.39 for behavior. The College Perspectives around FoodInsecurity survey can be used to better understand internal and external factors asso-ciated with food insecurity in college students, which can inform interventions aimed atassisting this population.
• Kilgrow, J., Gamble, E., Meier, A., Lyman, K., Barney, A., Kartchner, C., Martinez, P., Lee, K., Mathusek, C., Ang, K., Green, B. M., Banna, J., Eggett, D. L., Grutzmacher, S., Jackson, J. A., OoNorasak, K., Stokes, N., & Richards, R. (2025). Development, validation, and reliability testing of the College Perspectives around Food Insecurity survey. PloS one, 20(1), e0317444.
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  The objective of this study was to develop and to test the validity and reliability of a survey aimed to evaluate internal and external factors associated with college food insecurity. Researchers used a mixed methods approach to evaluate the College Perspectives around Food Insecurity survey. Survey items were constructed from interview data and assigned a social cognitive theory concept (environment, personal, or behavior). Two rounds of expert reviews established content validity (Round 1, n = 3; Round 2, n = 2). Researchers evaluated face validity through two rounds of cognitive interviews with college students 18+ years old (Round 1, n = 9; Round 2, n = 16) and tested survey reliability (n = 105). Researchers used descriptive statistics, test-retest reliability statistics, and Cronbach's alpha scores for data analysis. The initial survey contained 143 items. After feedback from expert reviewers and cognitive interviews, the final survey contained 99 items. Test-retest reliability was 0.99, and Cronbach's alpha scores were 0.74 for environment, 0.47 for personal, and 0.39 for behavior. The College Perspectives around Food Insecurity survey can be used to better understand internal and external factors associated with food insecurity in college students, which can inform interventions aimed at assisting this population.
• Garcia, J., Vaughn, A., Abreu, C., Blodgett, J., Carrillo, E., Contreras, R., Endinjok, F., Grutzmacher, S., Gunter, K., Harvey, S., Kothari, B., Mojica, C., Rothwell, D., & MacTavish, K. (2024). Developing a Strategic “Container” to Support Boundary Spanning and Belonging Amongst Diverse Collaborators at a Land-Grant University. Journal of Higher Education Outreach and Engagement, 28(3).
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  This essay reports on engaging academic and community partners whose positionalities spanned diverse lived experiences and power structures. Using groundwork from several literatures, we reflect on developing, nurturing, repairing, and expanding a container as a critically reflective space for experimenting with new ways of being and doing. A well-curated and nurtured container creates processes and spaces where group members feel they belong; they commit to practice a shared set of agreements, and work through interpersonal and organizational conflict that will inevitably arise. The container can be an instrument for identity, organizational, and tactical boundary spanning. As a microsystem, a container can mobilize collective engagement when team members reflect diverse identities, hierarchies, and roles within the academic system and partnering communities. Theorizing the container as an opportunity structure for boundary spanning may help those advancing diversity, equity, inclusion, and justice (DEIJ) within academic land-grant institutions, university–community collaboratives, and community-based organizations.
• Garcia, J., Vaughn, A., Arredondo Abreu, C., Blodgett, J., Carrillo, E., Contreras, R., Endinjok, F., Grutzmacher, S. K., Gunter, K., Harvey, S. M., Kothari, B., Mojica, C., Rothwell, D., & MacTavish, K. (2024). Developing a strategic “container” to support boundary spanning and belonging amongst collaborators at a land-grant university.. Journal of Higher Education Outreach and Engagement, 28(3), 97.
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  This essay reports on engaging academic and community partners whosepositionalities spanned diverse lived experiences and power structures.Using groundwork from several literatures, we reflect on developing,nurturing, repairing, and expanding a container as a critically reflectivespace for experimenting with new ways of being and doing. A well-curated and nurtured container creates processes and spaces wheregroup members feel they belong; they commit to practice a shared setof agreements, and work through interpersonal and organizationalconflict that will inevitably arise. The container can be an instrumentfor identity, organizational, and tactical boundary spanning. As amicrosystem, a container can mobilize collective engagement whenteam members reflect diverse identities, hierarchies, and roles withinthe academic system and partnering communities. Theorizing thecontainer as an opportunity structure for boundary spanning may helpthose advancing diversity, equity, inclusion, and justice (DEIJ) withinacademic land-grant institutions, university–community collaboratives,and community-based organizations.
• Munger, A. L., Speirs, K. E., Grutzmacher, S. K., & Edwards, M. (2024). Social Service Providers' Perceptions of Older Adults' Food Access During COVID-19. Journal of aging & social policy, 36(6), 1244-1261.
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  The COVID-19 pandemic exacerbated risk factors for food insecurity among older adults, while also altering how government agencies and social service organizations could serve this population given their disproportionate vulnerability to the virus. The current study sought to understand social service providers' perspectives about how low-income community-dwelling older adults' access to food and related resources changed during the COVID pandemic. Data were collected via in-depth interviews with 22 social service providers from Oregon-based public and private social service agencies. Responses indicated that changes to older adults' food access during the pandemic stemmed from increases in public benefit amounts and social distancing guidelines. Participants indicated that temporary increases in SNAP allotments supported older adults' food security. Additionally, social distancing guidelines disrupted usual ways of procuring food, such as going to grocery stores, obtaining food with the assistance of family or neighbors, receiving deliveries from social programs, and visiting congregate meal sites. Food assistance programs changed their operations to reduce in-person interaction and increase the use of technology. When investigating older adults' food access, future research should consider adults' experiences of and barriers to SNAP receipt, social support from social networks and safety net programs, and technology access and knowledge.
• Rockler, B. E., Grutzmacher, S. K., Garcia, J., Smit, E., & Braverman, M. (2024). Psychosocial factors play a central role in determining SNAP utilization for farm workforce. Frontiers in public health, 12, 1402142. doi:10.1007/s10460-023-10448-0
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  Introduction: Federal food safety net programs, like the Supplemental NutritionAssistance Program (SNAP), may not reach vulnerable populations like ruralresidents, immigrants, and Latinx individuals. Because these groups areoverrepresented among the farm workforce, exploring SNAP utilization amongfarm communities may clarify the role it plays in alleviating food insecurity.Methods: In-depth interviews were conducted with 31 farmworkers and farmowners. Patterns and predictors of SNAP utilization were organized using anadapted Andersen Behavioral Model of Health Service Utilization.Results: Psychosocial factors played the central role in participants’ use of SNAP.Discussion: Opportunities to improve the design and delivery of SNAP includeexpanded eligibility cut-offs and targeted engagement mechanisms.
• Rockler, B., Grutzmacher, S., Garcia, J., Smit, E., & Braverman, M. (2024). Psychosocial factors play a central role in determining SNAP utilization for farm workforce. Frontiers in Public Health, 12. doi:10.3389/fpubh.2024.1402142
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  Introduction: Federal food safety net programs, like the Supplemental Nutrition Assistance Program (SNAP), may not reach vulnerable populations like rural residents, immigrants, and Latinx individuals. Because these groups are overrepresented among the farm workforce, exploring SNAP utilization among farm communities may clarify the role it plays in alleviating food insecurity. Methods: In-depth interviews were conducted with 31 farmworkers and farm owners. Patterns and predictors of SNAP utilization were organized using an adapted Andersen Behavioral Model of Health Service Utilization. Results: Psychosocial factors played the central role in participants’ use of SNAP. Discussion: Opportunities to improve the design and delivery of SNAP include expanded eligibility cut-offs and targeted engagement mechanisms.
• Munger, A., Speirs, K., Grutzmacher, S., & Edwards, M. (2023). Social Service Providers’ Perceptions of Older Adults’ Food Access During COVID-19. Journal of Aging and Social Policy. doi:10.1080/08959420.2023.2205770
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  The COVID-19 pandemic exacerbated risk factors for food insecurity among older adults, while also altering how government agencies and social service organizations could serve this population given their disproportionate vulnerability to the virus. The current study sought to understand social service providers’ perspectives about how low-income community-dwelling older adults’ access to food and related resources changed during the COVID pandemic. Data were collected via in-depth interviews with 22 social service providers from Oregon-based public and private social service agencies. Responses indicated that changes to older adults’ food access during the pandemic stemmed from increases in public benefit amounts and social distancing guidelines. Participants indicated that temporary increases in SNAP allotments supported older adults’ food security. Additionally, social distancing guidelines disrupted usual ways of procuring food, such as going to grocery stores, obtaining food with the assistance of family or neighbors, receiving deliveries from social programs, and visiting congregate meal sites. Food assistance programs changed their operations to reduce in-person interaction and increase the use of technology. When investigating older adults' food access, future research should consider adults’ experiences of and barriers to SNAP receipt, social support from social networks and safety net programs, and technology access and knowledge.
• Rockler, B. E., Grutzmacher, S. K., Garcia, J., Braverman, M. T., & Smit, E. (2023). Something to eat: experiences of food insecurity on the farm. Agriculture and human values, 1-18.
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  The health of farm owners and farmworkers has significant impacts on farm businesses, farming families, and local rural communities where agriculture is an important driver of social and economic activity. Rural residents and farmworkers have higher rates of food insecurity, but little is known about food insecurity among farm owners and the collective experiences of farm owners and farmworkers. Researchers and public health practitioners have stressed the need for policies that target the health and well-being of farm owners and farmworkers while remaining sensitive to the nature of life on the farm, yet farm owner and farmworker lived experiences have been understudied, especially in relation to one another. In-depth qualitative interviews were conducted with 13 farm owners and 18 farmworkers in Oregon. Modified grounded theory was used to analyze interview data. Data were coded using a three-stage process to identify salient core characteristics of food insecurity. Farm owner and farmworker meanings and interpretations of their food insecurity were often contradicted by evaluated food security scores using validated quantitative measures. According to such measures, 17 experienced high food security, 3 had marginal food security, and 11 had low food security, but narrative experiences suggested higher rates. Narrative experiences were categorized by core characteristics of food insecurity, including seasonal food shortages, resource stretching, working extended hours most days of the week, limited use of food assistance, and the tendency to downplay hardship. These unique factors have important implications for developing responsive policies and programs to support the health and well-being of farm livelihoods whose work enables health and well-being among consumers. Future studies to test the relationships between the core characteristics of food insecurity identified in this study and farm owner and farmworker meanings and interpretations of food insecurity, hunger, and nourishment are warranted.
• Rockler, B., Grutzmacher, S., Garcia, J., Braverman, M., & Smit, E. (2023). Something to eat: experiences of food insecurity on the farm. Agriculture and Human Values, 40(4). doi:10.1007/s10460-023-10448-0
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  The health of farm owners and farmworkers has significant impacts on farm businesses, farming families, and local rural communities where agriculture is an important driver of social and economic activity. Rural residents and farmworkers have higher rates of food insecurity, but little is known about food insecurity among farm owners and the collective experiences of farm owners and farmworkers. Researchers and public health practitioners have stressed the need for policies that target the health and well-being of farm owners and farmworkers while remaining sensitive to the nature of life on the farm, yet farm owner and farmworker lived experiences have been understudied, especially in relation to one another. In-depth qualitative interviews were conducted with 13 farm owners and 18 farmworkers in Oregon. Modified grounded theory was used to analyze interview data. Data were coded using a three-stage process to identify salient core characteristics of food insecurity. Farm owner and farmworker meanings and interpretations of their food insecurity were often contradicted by evaluated food security scores using validated quantitative measures. According to such measures, 17 experienced high food security, 3 had marginal food security, and 11 had low food security, but narrative experiences suggested higher rates. Narrative experiences were categorized by core characteristics of food insecurity, including seasonal food shortages, resource stretching, working extended hours most days of the week, limited use of food assistance, and the tendency to downplay hardship. These unique factors have important implications for developing responsive policies and programs to support the health and well-being of farm livelihoods whose work enables health and well-being among consumers. Future studies to test the relationships between the core characteristics of food insecurity identified in this study and farm owner and farmworker meanings and interpretations of food insecurity, hunger, and nourishment are warranted.
• Speirs, K., Grutzmacher, S., Munger, A., & Ottusch, T. (2023). How Do U.S. Colleges and Universities Help Students Address Basic Needs? A National Inventory of Resources for Food and Housing Insecurity. Educational Researcher, 52(1). doi:10.3102/0013189X221139292
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  This study documents the resources U.S. colleges and universities offer to address student food and housing insecurity and explores differences across community colleges, four-year public schools, and four-year private schools. Using a stratified random sample (n = 448) of U.S. postsecondary institutions, a systematic web search for evidence of 18 resources was conducted. A framework for classifying resources was developed. Logistic regression was used to explore differences by institution type. Eighty-eight percent of the schools in the sample offered at least one resource. On average, schools offered four resources. Food pantries were the most frequently offered resource, while providing information about low-cost campus dining options was the least frequently offered. Four-year private schools offered fewer resources than four-year public schools and community colleges.
• Alonso Street, E. M., Grutzmacher, S., Branscum, A., & Smit, E. (2022). Self-Perceived Health and Chronic Conditions Among Users of Supplements With and Without Botanical Ingredients: Findings from the 2009-2014 National Health and Nutrition Examination Survey. Journal of dietary supplements, 19(6), 689-703.
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  The objective of this research was to investigate associations among self-reported health status, chronic conditions, and use of dietary supplements containing botanicals and describe reasons for use among U.S. adult supplement users. This was a cross-sectional analysis using data from the 2009-2014 National Health and Nutrition Examination Survey (NHANES). Supplement information was collected with a 30-day recall interview. Self-reported general health status and doctor-informed diagnoses of chronic conditions were assessed using a health status questionnaire. We used weighted multivariate logistic regressions to assess associations between supplement use and perceived health and number of chronic conditions. Participants were 16,958 non-institutionalized U.S. adults aged 20 years and older. Adults with excellent or very good self-perceived health were more likely to use botanical supplements than adults with good perceived health (adjusted odds ratio [aOR], 1.48; 95% confidence interval [CI], 1.28-1.74). Adults with three or more chronic conditions were more likely to report using botanical supplements than adults with no chronic conditions (aOR, 1.49; 95% CI, 1.13-1.69). The most frequently reported reasons for both non-botanical and botanical supplements use were "personal choice or influenced by advertisements or word of mouth," "improve health," and "specific health conditions" (93.3%, 84.2%, and 64.7%, respectively). While perceptions of health are more positive among adults using botanical supplements, chronic conditions and reasons for botanical supplements use related to personal choice, improving health, or addressing specific conditions were more likely. Differentiating botanical supplements from other complementary and integrative therapies may be useful for facilitating a deeper understanding of the reasons.
• Alonso Street, E., Grutzmacher, S., Branscum, A., & Smit, E. (2022). Self-Perceived Health and Chronic Conditions Among Users of Supplements With and Without Botanical Ingredients: Findings from the 2009–2014 National Health and Nutrition Examination Survey. Journal of Dietary Supplements, 19(6). doi:10.1080/19390211.2021.1924336
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  The objective of this research was to investigate associations among self-reported health status, chronic conditions, and use of dietary supplements containing botanicals and describe reasons for use among U.S. adult supplement users. This was a cross-sectional analysis using data from the 2009–2014 National Health and Nutrition Examination Survey (NHANES). Supplement information was collected with a 30-day recall interview. Self-reported general health status and doctor-informed diagnoses of chronic conditions were assessed using a health status questionnaire. We used weighted multivariate logistic regressions to assess associations between supplement use and perceived health and number of chronic conditions. Participants were 16,958 non-institutionalized U.S. adults aged 20 years and older. Adults with excellent or very good self-perceived health were more likely to use botanical supplements than adults with good perceived health (adjusted odds ratio [aOR], 1.48; 95% confidence interval [CI], 1.28–1.74). Adults with three or more chronic conditions were more likely to report using botanical supplements than adults with no chronic conditions (aOR, 1.49; 95% CI, 1.13–1.69). The most frequently reported reasons for both non-botanical and botanical supplements use were “personal choice or influenced by advertisements or word of mouth,” “improve health,” and “specific health conditions” (93.3%, 84.2%, and 64.7%, respectively). While perceptions of health are more positive among adults using botanical supplements, chronic conditions and reasons for botanical supplements use related to personal choice, improving health, or addressing specific conditions were more likely. Differentiating botanical supplements from other complementary and integrative therapies may be useful for facilitating a deeper understanding of the reasons.
• Crespo-Bellido, M., Takata, Y., Jackson, J., Grutzmacher, S., & Smit, E. (2022). Dietary Quality and Caloric Contribution of the Alternative Food Acquisitions of U.S. Low-income Households: Results from the National Food Acquisition and Purchasing Survey (Foodaps). Journal of Hunger and Environmental Nutrition, 17(5). doi:10.1080/19320248.2021.1901170
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  Low-income households may acquire foods from purchases, federal food assistance, and alternative food sources (AFS) to meet their food needs. The objectives of this study were to quantify and compare the contribution of AFS to total kilocalories and dietary quality of food acquisitions between AFS users and non-users among low-income households. Users obtained 22.3% of kilocalories from AFS and purchased fewer kilocalories compared to non-users [14,886 ± 1464.10 versus 19,915.00 ± 1036.41 kilocalories]. AFS users had lower 2015-Healthy Eating Index scores from purchased acquisitions than non-users, but there was no difference in dietary quality between AFS users and non-users after accounting for alternative acquisitions.
• Giordono, L., Rothwell, D., Grutzmacher, S., & Edwards, M. (2022). Understanding SNAP use patterns among older adults. Applied Economic Perspectives and Policy, 44(2). doi:10.1002/aepp.13228
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  Participation rates by older adults in the Supplemental Nutrition Assistance Program (SNAP) have increased since 2010 but remain lower than other groups despite high food insecurity. This study examines patterns of SNAP participation among older adults aged 51–69 years. Using longitudinal SNAP administrative data from Oregon (2014–2018), we find that older adults with long-term SNAP receipt (>55 months) represent the majority of this group at any given time, suggesting that lower participation rates likely reflect challenges of take-up, rather than persistence. But younger cohorts (ages 51–59) experience lower persistence than older cohorts (ages 60–69), suggesting that approaching retirement presents a distinct set of challenges.
• Munger, A., Grutzmacher, S., & Rockler, B. (2022). Vulnerabilities to Food Insecurity: Interconnected Risks and Assets for Coping Among Low-Income Men. Journal of the Society for Social Work and Research, 13(4). doi:10.1086/713477
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  Objective: A consideration of low-income men’s social, economic, and environmental contexts reveals potential vulnerabilities to food insecurity, yet their experiences of food insecurity have not been well documented. As such, this paper explores the risks and assets for food insecurity as described by a sample of 30 low-income men. Method: Data were collected through in-depth semistructured interviews that took place in 11 Department of Social Services offices in five geograph-ically diverse Maryland counties. We used thematic analysis to analyze the data. Findings: Participants reported experiencing multiple, co-occurring, and accumulat-ing hardships that interfered with meeting basic needs and accessing food. Risks included health problems, limited employment, lack of transportation, and housing problems. Assets for coping included financial management skills, relationships, and public and private community assistance, particularly SNAP. Conclusions: Findings indicate that although policies and programs targeting one area of hardship may help meet immediate needs, they do not address the interconnected root causes and consequences of poverty. Policies and programs should support and leverage existing assets of low-income men to amplify programmatic benefits.
• Rockler, B. E., Grutzmacher, S. K., Garcia, J., & Smit, E. (2022). The role of SNAP and WIC participation and racialized legal status in U.S. farmworker health. PloS one, 17(8), e0272911.
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  Policies that restrict access to and use of the Supplemental Nutrition Assistance Program (SNAP) and Special Supplemental Nutrition Assistance Program for Women, Infants, and Children (WIC) by legal status may disproportionately disadvantage particular racial and ethnic groups. While immigrant legal status, race, and ethnicity are recognized as independent social determinants of health, studies examining the extent to which legal status structures racial and ethnic health disparities are limited. Research is needed to identify factors that mitigate disparate health outcomes, such as SNAP and WIC.
• Rockler, B., Grutzmacher, S., Garcia, J., & Smit, E. (2022). The role of SNAP and WIC participation and racialized legal status in U.S. farmworker health. PLoS ONE, 17(8). doi:10.1371/journal.pone.0272911
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  Background Policies that restrict access to and use of the Supplemental Nutrition Assistance Program (SNAP) and Special Supplemental Nutrition Assistance Program for Women, Infants, and Children (WIC) by legal status may disproportionately disadvantage particular racial and ethnic groups. While immigrant legal status, race, and ethnicity are recognized as independent social determinants of health, studies examining the extent to which legal status structures racial and ethnic health disparities are limited. Research is needed to identify factors that mitigate disparate health outcomes, such as SNAP and WIC. Methods Cross-sectional data from the 2009/2010 National Agricultural Workers Survey (N = 3,961) were analyzed. Chi-square tests and logistic regressions examined associations among self-reported health, race, ethnicity, legal status, and SNAP/WIC participation. Results Farmworkers reporting excellent or good health were more likely to be non-Hispanic White, U.S. citizen, aged 18–25, single, male, educated beyond primary school, living above the poverty level, without chronic health conditions, and located in the Midwest. Hispanic farmworkers had lower odds of reporting excellent or good health (OR 0.27, 95% CI 0.12–0.62). Among SNAP/WIC participants, Hispanic farmworkers had higher odds of reporting excellent or good health (OR 6.74, 95% CI 1.54–29.57) compared to non-Hispanic White farmworkers. There was no significant association between self-reported health and legal status. Discussion This study complements the extant literature showing racial and ethnic health disparities among the U.S. farmworker population. Results provide valuable insight on the health-protective potential of programs like SNAP and WIC, particularly among Hispanic farmworkers, who may be both less likely to be eligible and more hesitant to participate. These findings underscore the need to expand U.S. farmworkers’ eligibility and participation in SNAP and WIC.
• Crespo-Bellido, M. S., Grutzmacher, S. K., Takata, Y., & Smit, E. (2021). The Association Between Food-Away-From-Home Frequency and a Higher BMI Varies by Food Security Status in US Adults. The Journal of nutrition, 151(2), 387-394.
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  For decades, Americans have increasingly relied on food away from home (FAFH) despite its association with negative health outcomes. Little is known about FAFH frequency and expenditures of adults with lower food security (FS) and their association with health outcomes, such as BMI.
• Crespo-Bellido, M., Grutzmacher, S., & Smit, E. (2021). Food security and alternative food acquisition among US low-income households: results from the National Food Acquisition and Purchasing Survey (FoodAPS). Public health nutrition, 24(5), 787-795.
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  To determine the characteristics of US low-income households that use alternative food acquisition strategies and to examine the association between food security and alternative food acquisition.
• Crespo-Bellido, M., Grutzmacher, S., Takata, Y., & Smit, E. (2021). The Association between Food-Away-From-Home Frequency and a Higher BMI Varies by Food Security Status in US Adults. Journal of Nutrition, 151(2). doi:10.1093/jn/nxaa364
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  Background: For decades, Americans have increasingly relied on food away from home (FAFH) despite its association with negative health outcomes. Little is known about FAFH frequency and expenditures of adults with lower food security (FS) and their association with health outcomes, such as BMI. Objectives: We evaluated patterns of adults' FAFH purchases by FS status and other demographic characteristics, and examined the association between FAFH frequency and BMI in adults of varying levels of FS. Methods: This cross-sectional study used data from the Consumer Behavior Survey, Food Security Survey, and anthropometric measurements to assess FAFH frequency and expenditures, FS, and calculated BMI of adults (≥18 y) who participated in the NHANES 2007-2014 (n = 20,733). We used multinomial logistic regression to examine the association between FAFH frequency quartiles (quartile 1: 0 n/wk; quartile 2: 1-2 n/wk; quartile 3: 3-4 n/wk; quartile 4: ≥5 n/wk) and BMI by FS category. Results: Although FAFH frequency was similar across FS levels, adults with high FS spent more dollars (${\$}$213.60) and a greater proportion (29.4%) of their food budget on FAFH compared with adults with marginal, low, and very low FS (${\$}$133.00, ${\$}$116.20, ${\$}$103.30 and 21.4%, 19.7%, 20.0%, respectively). Obesity prevalence was highest in adults with low FS (42.9%) and very low FS (41.5%), and lowest in adults with high FS (33.7%). FAFH frequency and BMI were positively associated in adults with high (P < 0.001), marginal (P = 0.025), and low (P = 0.024) FS, but not in adults with very low FS (P = 0.589). Conclusions: FAFH is frequent in adults regardless of FS status. The positive association between FAFH and BMI is the strongest in adults with high FS, the group with the lowest prevalence of obesity. Conversely, BMI was not associated with FAFH in adults with very low FS, despite their higher prevalence of obesity.
• Yimer, N. B., Mohammed, M. A., Solomon, K., Tadese, M., Grutzmacher, S., Meikena, H. K., Alemnew, B., Sharew, N. T., & Habtewold, T. D. (2021). Cervical cancer screening uptake in Sub-Saharan Africa: a systematic review and meta-analysis. Public health, 195, 105-111.
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  The objective of this study is to estimate the pooled uptake of cervical cancer screening and identify its predictors in Sub-Saharan Africa.
• Craddock, H., Maring, E., & Grutzmacher, S. (2020). Foodborne Illness Prevention In Debre Berhan, Ethiopia: Preliminary Efforts To Understand Household Agricultural Practices. African Journal of Food, Agriculture, Nutrition and Development, 20(1). doi:10.18697/ajfand.89.17810
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  While strategies to mitigate risks for foodborne illness and childhood diarrhea via sanitation and behavioral interventions have been explored, there is a dearth of knowledge about household practices regarding food production and use, livestock, and other sources of risk for foodborne illness in urban and peri-urban areas. The objective of this research was to increase understanding of household agricultural practices in Debre Berhan, Ethiopia in order to design targeted behavioral interventions to improve food safety and decrease diarrheal disease. A convenience sample of 21 teachers and parents were recruited for a mixed-methods pilot survey. The survey covered topical areas such as methods for growing, washing, and cooking produce, specifically focusing on practices in home vegetable gardens. Participants were also asked about fertilizers and manures used, animals on the property, and irrigation water sources. Descriptive statistics were calculated, and data were analyzed with SAS 9.2. The majority of participants (76.2%) reported growing some or all of their own food, and many used compost (62.5%) and manure (62.5%) as fertilizer. Uncomposted manure was used as fertilizer by half (50.0%) of respondents who reported the use of manure. Respondents most commonly reported raising chickens (23.8%), yet among those using manure, they most commonly reported using sheep or lamb manure as fertilizer (50%). Most (93.7%) respondents used municipal water to irrigate their crops, while none of the respondents reported using surface water to irrigate. Nearly all (95.2%) reported always washing their produce before eating it. Respondents most commonly requested education regarding how to more effectively grow produce. This study suggests that children and adults in Debre Berhan may have a high risk of exposure to pathogens via contact with uncomposted manure and multiple species of animals. Findings identify an opportunity for increased education in the topical areas of urban agriculture and diarrheal disease prevention. In particular, education regarding the safe utilization of manure as fertilizer could be included in agricultural extension programs. Additional research is needed to understand the extent of exposure via common household sources to pathogens that cause diarrheal disease.
• Grutzmacher, S., Munger, A., Messina, L., & Downes, K. (2020). Screening for Health Literacy among SNAP-eligible Adults Using the Newest Vital Sign: Implications for Nutrition Facts Label Policy and Education. Journal of Hunger and Environmental Nutrition, 15(3). doi:10.1080/19320248.2019.1590277
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  This study examines the role of computational and Nutrition Facts Label (NFL) skills in health literacy classifications using the Newest Vital Sign (NVS). A convenience sample of 144 SNAP-eligible adults was given an original and modified version of the NVS. Responses on NVS and modified NVS (NVS-M) were compared using a paired McNemar test, while the order of administration was evaluated using a chi-square test. Overall, significant differences between the paired NVS and NVS-M responses (p < 0.001) resulted in more classifications of adequate health literacy with the NVS-M. Stratification by order of administration revealed a version-specific priming effect, but a comparison of the first administration of each assessment showed no significant difference in classifications (p = 0.955). Common incorrect responses reflected computational errors and confounding serving size and servings per container. Nutrition education may improve NFL skills, while limited numeracy may undermine their utility. Differentiation among related health literacy concepts could improve measurement and screening.
• Rockler, B. E., Grutzmacher, S., Smit, E., & Notarianni, M. (2020). Participant Perceptions of the Double Up Food Bucks Program at Oregon Farmers' Markets. Journal of nutrition education and behavior, 52(11), 1043-1051.
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  To explore perceptions of program impact among Double Up Food Bucks participants in Oregon.
• Rockler, B., Grutzmacher, S., Smit, E., & Notarianni, M. (2020). Participant Perceptions of the Double Up Food Bucks Program at Oregon Farmers’ Markets. Journal of Nutrition Education and Behavior, 52(11). doi:10.1016/j.jneb.2020.02.016
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  Objective: To explore perceptions of program impact among Double Up Food Bucks participants in Oregon. Methods: Data were collected from 1,223 Double Up Food Bucks participants at 42 Oregon farmers’ markets. Chi-square tests of independence and logistic regressions were used to examine associations among key variables. Results: Most participants reported buying more fruits and vegetables (FVs) (91.0%), trying new FV types (82.2%), eating less processed food (69.8%), having more food available at home (81.1%), and perceiving improvements in health (87.9%). Perceptions of affordability were higher among younger adults (P < 0.001) and households with 3–5 people (P = 0.02), with children (P < 0.001), and without chronic disease (P = 0.003). Perceptions of increased FV purchases were higher in households with children (P = 0.009) and reported overall health improvements were higher among non-White participants (P = 0.04). Perceptions of increased FV purchases and affordability were associated with other positive program outcomes. Conclusions and Implications: Participants may perceive barriers to purchasing FVs from farmers’ markets, which are not fully addressed by the increased purchasing power from a FV incentive. Targeted redesign, outreach, and education may improve program experiences among groups with less positive perceptions. Further research to identify explanations for variation in program experience is needed.
• Grutzmacher, S. K., Munger, A. L., Speirs, K. E., Vafai, Y., Hilberg, E., Braunscheidel Duru, E., Worthington, L., & Lachenmayr, L. (2019). Predicting Attrition in a Text-Based Nutrition Education Program: Survival Analysis of Text2BHealthy. JMIR mHealth and uHealth, 7(1), e9967.
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  Text-based programs have been shown to effectively address a wide variety of health issues. Although little research examines short message service (SMS) text messaging program characteristics that predict participant retention and attrition, features of SMS text message programs, such as program duration and intensity, message content, and the participants' context, may have an impact. The impact of stop messages-messages with instructions for how to drop out of an SMS text message program-may be particularly important to investigate.
• Grutzmacher, S., Munger, A., Speirs, K., Vafai, Y., Hilberg, E., Duru, E., Worthington, L., & Lachenmayr, L. (2019). Predicting attrition in a text-based nutrition education program: Survival analysis of Text2bhealthy. JMIR mHealth and uHealth, 7(1). doi:10.2196/mhealth.9967
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  Background: Text-based programs have been shown to effectively address a wide variety of health issues. Although little research examines short message service (SMS) text messaging program characteristics that predict participant retention and attrition, features of SMS text message programs, such as program duration and intensity, message content, and the participants’ context, may have an impact. The impact of stop messages—messages with instructions for how to drop out of an SMS text message program—may be particularly important to investigate. Objective: The aim of this study was to describe attrition from Text2BHealthy, a text-based nutrition and physical activity promotion program for parents of low-income elementary school children, and to determine the impact of message content and number of stop messages received on attrition. Methods: Using data from 972 parents enrolled in Text2BHealthy, we created Kaplan-Meier curves to estimate differences in program duration for different SMS text message types, including nutrition, physical activity, stop, and other messages. Covariates, including rurality and number of stop messages received, were included. Results: Retention rates by school ranged from 74% (60/81) to 95.0% (132/139), with an average retention rate of 85.7% (833/972) across all schools. Program duration ranged from 7 to 282 days, with a median program duration of 233 days and an average program duration of 211.7 days. Among those who dropped out, program duration ranged from 7 to 247 days, with a median program duration of 102.5 days. Receiving a stop message increased the probability of attrition compared with receiving messages about nutrition, physical activity, or other topics (hazard ratio=51.5, 95% CI 32.46-81.7; P
• Akibu, M., Tekelab, T., Amano, A., Besho, M., Grutzmacher, S., Tadese, M., & Habtewold, T. (2018). Adherence to prenatal iron-folic acid supplementation in low- and middle-income countries (LMIC): A protocol for systematic review and meta-analysis. Systematic Reviews, 7(1). doi:10.1186/s13643-018-0774-x
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  Background: Daily iron-folic acid supplementation reduces anemia and various adverse obstetric outcomes such as preterm delivery, low birthweight, hemorrhage, and perinatal and maternal morbidity and mortality. However, its supplementation has not been successful that attributed to several determinants including poor adherence. Therefore, we aimed to conduct a systematic review and meta-analysis on the prevalence and determinants of adherence to prenatal iron-folic acid supplementation in low- and middle-income countries. In addition, we will develop a conceptual framework in the context of low- and middle-income countries (LMIC). Methods/design: We will search PubMed, MEDLINE, EMBASE, EBSCO, Web of Science, SCOPUS, WHO Global Index Medicus, and African Journals Online (AJOL) databases to retrieve relevant literatures. Observational (i.e., case-control, cohort, cross-sectional, survey, and surveillance reports) and quasi-randomized and randomized controlled trial studies conducted in LMIC will be included. The Newcastle-Ottawa Scale (NOS) and Joanna Briggs Institute (JBI) critical appraisal checklist will be used to assess the quality of observational and randomized controlled trial studies respectively. The pooled prevalence and odds ratio of determinants of adherence will be generated using a weighted inverse-variance meta-analysis model. Statistical heterogeneity among studies will be assessed by Cochran's Q χ 2 statistics and Higgins (I 2 statistics) method. The result will be presented using forest plots and Harvest plots when necessary. Furthermore, we will perform Jackknife sensitivity and subgroup analysis. Data will be analyzed using comprehensive meta-analysis software (version 2). Discussion: Contemporary evidence about the prevalence and determinants of adherence in LMIC will be synthesized to generate up-to-date knowledge. To our knowledge, this is the first systematic review. It would have substantial implications for researchers, clinicians, and policymakers for optimizing maternal and child health outcomes in LMIC. Systematic review registration: The protocol has been registered on International Prospective Register of Systematic Review (PROSPERO), University of York Center for Reviews and Dissemination ( https://www.crd.york.ac.uk/ ), registration number CRD42017080245.
• Akibu, M., Tekelab, T., Amano, A., Besho, M., Grutzmacher, S., Tadese, M., & Habtewold, T. D. (2018). Adherence to prenatal iron-folic acid supplementation in low- and middle-income countries (LMIC): a protocol for systematic review and meta-analysis. Systematic reviews, 7(1), 107.
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  Daily iron-folic acid supplementation reduces anemia and various adverse obstetric outcomes such as preterm delivery, low birthweight, hemorrhage, and perinatal and maternal morbidity and mortality. However, its supplementation has not been successful that attributed to several determinants including poor adherence. Therefore, we aimed to conduct a systematic review and meta-analysis on the prevalence and determinants of adherence to prenatal iron-folic acid supplementation in low- and middle-income countries. In addition, we will develop a conceptual framework in the context of low- and middle-income countries (LMIC).
• Grutzmacher, S., Braunscheidel Duru, E., Speirs, K., Worthington, L., Munger, A., & Lachenmayr, L. (2018). Using text messages to engage low-income parents in school-based nutrition education. Journal of Hunger and Environmental Nutrition, 13(3). doi:10.1080/19320248.2017.1364196
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  Because children spend significant time in school settings, school-based programs have great potential to prevent childhood obesity. Nutrition education and physical activity programs may be more effective, however, when they engage parents to reinforce key messages and behaviors outside of school settings. The Maryland Food Supplement Nutrition Education program (FSNE) partnered with 23 Title I elementary schools in Maryland to develop and administer Text2BHealthy, an innovative text message program that engages parents in their children’s school-based nutrition education. Text2BHealthy sends 2 behaviorally focused text messages to enrolled parents each week. These messages provide actionable nudges that encourage improved nutrition and physical activity and reference upcoming free or low-cost opportunities and events in the child’s school and the surrounding community. Preliminary evaluation results suggest that Text2BHealthy resulted in improvements on a number of fruit and vegetable practices of parents and their children. Additional evaluation research is needed to demonstrate efficacy of text message programs and program components.
• Grutzmacher, S. K., Munger, A. L., Speirs, K. E., Zemeir, L. A., Richard, K. C., & Worthington, L. (2017). Feasibility of bidirectional text messages in evaluating a text-based nutrition education program for low-income parents: Results from the Text2BHealthy program. Evaluation and program planning, 64, 90-94.
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  Text messages are increasingly used in the delivery of health education programs. One appealing aspect of this approach is the possibility of remotely collecting participant data to use in program tailoring or evaluation. The purpose of the present study is to test the feasibility of using text messages to collect participant data. Using data from 33 texted evaluation questions sent through the Text2BHealthy nutrition education program for low-income parents (n=108-1521) response rates under different incentive and prompting strategies were examined. Response rates are generally low across a pilot year and three program years, ranging from 10-55%. While incentives seemed to be ineffective at improving response rates, results indicate that prompting participants to respond may increase response rates. Individuals who respond to an initial question are highly likely to respond to a follow-up question (88-99%) and to report positive behaviors (68-100%). Responses received through text may be unrepresentative and positively biased. Text messages may be a supplemental data collection strategy in nutrition education programs, but low response rates and response bias undermine data quality.
• Grutzmacher, S., Munger, A., Speirs, K., Zemeir, L., Richard, K., & Worthington, L. (2017). Feasibility of bidirectional text messages in evaluating a text-based nutrition education program for low-income parents: Results from the Text2BHealthy program. Evaluation and Program Planning, 64. doi:10.1016/j.evalprogplan.2017.04.001
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  Text messages are increasingly used in the delivery of health education programs. One appealing aspect of this approach is the possibility of remotely collecting participant data to use in program tailoring or evaluation. The purpose of the present study is to test the feasibility of using text messages to collect participant data. Using data from 33 texted evaluation questions sent through the Text2BHealthy nutrition education program for low-income parents (n = 108−1521) response rates under different incentive and prompting strategies were examined. Response rates are generally low across a pilot year and three program years, ranging from 10–55%. While incentives seemed to be ineffective at improving response rates, results indicate that prompting participants to respond may increase response rates. Individuals who respond to an initial question are highly likely to respond to a follow-up question (88–99%) and to report positive behaviors (68–100%). Responses received through text may be unrepresentative and positively biased. Text messages may be a supplemental data collection strategy in nutrition education programs, but low response rates and response bias undermine data quality.
• Davis, B., Grutzmacher, S., & Munger, A. (2016). Utilization of Social Support among Food Insecure Individuals: A Qualitative Examination of Network Strategies and Appraisals. Journal of Hunger and Environmental Nutrition, 11(2). doi:10.1080/19320248.2015.1066731
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  This study explored the role of social support as low-income individuals endure experiences of food insecurity. The sample includes 37 participants who indicated being challenged by food insecurity and identified using social networks in some capacity in the acquisition of food. Data was analyzed following a grounded theory approach. Participants emphasized the utility of networks (family, friends, coworkers, and neighbors) and the value of resource exchange and pooling strategies to reduce impacts of food insecurity. Attention is given to the appraisal process, which includes assessing one’s own needs and resources as well as their network’s ability to offer help. Important implications for policy and practice addressing social safety net and food programs are discussed.
• Munger, A. L., Hofferth, S. L., & Grutzmacher, S. K. (2016). The Role of the Supplemental Nutrition Assistance Program in the Relationship between Food Insecurity and Probability of Maternal Depression. Journal of hunger & environmental nutrition, 11(2), 147-161.
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  Food insecurity is a substantial stressor for many households. Though an association between food insecurity and depression has been well established, most studies have been cross-sectional. Although many receive benefits from the Supplemental Nutrition Assistance Program (SNAP), its role in reducing distress associated with food insecurity is unclear. Using data from 1,225 women who participated in the Fragile Families and Child Wellbeing Study, this study investigated 1) whether change in food security status predicts change in depression severity over a two-year period, 2) whether participating in SNAP predicts depression, and 3) whether the relationship between food insecurity and depression varies based on receipt of SNAP. Food insecurity was linked to probability of depression over time. Additionally, for those who became food insecure over the two-year period, losing SNAP benefits was associated with increased probability of depression, while gaining benefits was associated with reduced probability of depression. This suggests that the SNAP program offsets emotional hardship for those who have recently become food insecure. Further research is needed to evaluate the most efficient and efficacious means to reduce food insecurity and improve emotional wellbeing among vulnerable families.
• Munger, A., Hofferth, S., & Grutzmacher, S. (2016). The Role of the Supplemental Nutrition Assistance Program in the Relationship Between Food Insecurity and Probability of Maternal Depression. Journal of Hunger and Environmental Nutrition, 11(2). doi:10.1080/19320248.2015.1045672
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  ABSTRACT: Food insecurity is a substantial stressor for many households. Though an association between food insecurity and depression has been well established, most studies have been cross-sectional. Although many receive benefits from the Supplemental Nutrition Assistance Program (SNAP), its role in reducing distress associated with food insecurity is unclear. Using data from 1225 women who participated in the Fragile Families and Child Wellbeing Study, this study investigated whether (1) change in food security status predicts change in depression severity over a 2-year period, (2) participating in SNAP predicts depression, and (3) the relationship between food insecurity and depression varies based on receipt of SNAP. Food insecurity was linked to probability of depression over time. Additionally, for those who became food insecure over the 2-year period, losing SNAP benefits was associated with increased probability of depression, whereas gaining benefits was associated with reduced probability of depression. This suggests that the SNAP program offsets emotional hardship for those who have recently become food insecure. Further research is needed to evaluate the most efficient and efficacious means to reduce food insecurity and improve emotional well-being among vulnerable families.
• Song, H. J., Grutzmacher, S., & Munger, A. L. (2016). Project ReFresh: Testing the Efficacy of a School-Based Classroom and Cafeteria Intervention in Elementary School Children. The Journal of school health, 86(7), 543-51.
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  The purpose of this study was to assess the effect of a school-based nutrition program using a cafeteria environment intervention and classroom nutrition education on self-reported fruit and vegetable (FV) consumption, self-efficacy to select FV, and preference for healthy foods.
• Song, H., Grutzmacher, S., & Munger, A. (2016). Project ReFresh: Testing the Efficacy of a School-Based Classroom and Cafeteria Intervention in Elementary School Children. Journal of School Health, 86(7). doi:10.1111/josh.12404
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  BACKGROUND: The purpose of this study was to assess the effect of a school-based nutrition program using a cafeteria environment intervention and classroom nutrition education on self-reported fruit and vegetable (FV) consumption, self-efficacy to select FV, and preference for healthy foods. METHODS: Using quasi-experimental pre-post design with 3 study conditions, a total of 665 fourth- and fifth-grade students participated in the study. The comprehensive intervention included a behavioral economics cafeteria intervention and weekly classroom nutrition education for 1 academic year. The intervention was designed and delivered by the extension system. RESULTS: The comprehensive group showed significant improvement in some indicators including eating vegetables for lunch (p = .007), number of days eating vegetables (p < .001) and fruits (p < .001) in the last week, and self-efficacy in preparing FV at home (p = .034) compared to the control and cafeteria groups. Food preference of some food items, including oatmeal (p = .036 for cafeteria group, p < .001 for comprehensive group), whole grain noodles (p = .011 for comprehensive group), and vegetables (p = .003 for comprehensive group), significantly improved in the cafeteria and/or comprehensive group. CONCLUSIONS: Classroom nutrition education combined with cafeteria improvement has the potential to improve diet-related behavior of elementary school children. Also, collaborative partnership between schools and extension can enhance program sustainability.
• Speirs, K. E., Grutzmacher, S. K., Munger, A. L., & Messina, L. A. (2016). Recruitment and retention in an SMS-based health education program: Lessons learned from Text2BHealthy. Health informatics journal, 22(3), 651-8.
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  While text messages or short messaging service programs are increasingly utilized for delivering health education, few studies have explored the unique challenges of recruiting and retaining participants in such programs. This study utilizes survey and focus group data from Text2BHealthy, a short messaging service-based nutrition and physical activity promotion program, to examine barriers to enrollment and facilitators of retention among parents of elementary school students. Results show that participants were hard to reach with recruitment materials, had difficulty with self-enrollment, and were apprehensive about program costs. However, 89-90 percent of participants were retained. Results suggest that providing manual enrollment options, alternative program delivery methods (e.g. email messages), and opportunities to reenroll may facilitate participation in short messaging service-based health education and promotion programs.
• Speirs, K., Grutzmacher, S., Munger, A., & Messina, L. (2016). Recruitment and retention in an SMS-based health education program: Lessons learned from Text2BHealthy. Health Informatics Journal, 22(3). doi:10.1177/1460458215577995
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  While text messages or short messaging service programs are increasingly utilized for delivering health education, few studies have explored the unique challenges of recruiting and retaining participants in such programs. This study utilizes survey and focus group data from Text2BHealthy, a short messaging service-based nutrition and physical activity promotion program, to examine barriers to enrollment and facilitators of retention among parents of elementary school students. Results show that participants were hard to reach with recruitment materials, had difficulty with self-enrollment, and were apprehensive about program costs. However, 89-90 percent of participants were retained. Results suggest that providing manual enrollment options, alternative program delivery methods (e.g. email messages), and opportunities to reenroll may facilitate participation in short messaging service-based health education and promotion programs.
• Munger, A. L., Lloyd, T. D., Speirs, K. E., Riera, K. C., & Grutzmacher, S. K. (2015). More than Just Not Enough: Experiences of Food Insecurity for Latino Immigrants. Journal of immigrant and minority health, 17(5), 1548-56.
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  Undocumented Latino immigrants often struggle to provide food for their families. In an attempt to inform efforts to create effective programs and policies promoting food security, this study explored the experience of food insecurity for low-income, undocumented Latino immigrants. In-depth qualitative interviews were conducted with 24 undocumented Latino immigrants. Modified grounded theory was used to analyze the interview data. The experience of food insecurity was similar to other groups' experiences, as it entailed inadequate amount and quality of food. However, immigration and documentation status presented unique vulnerabilities for food insecurity related to unfamiliar food environments, remittances and separation, employment, and community and government resources. Cultural and structural factors that may shape the experience of and response to food insecurity are discussed along with implications for policy and programming.
• Munger, A., Lloyd, T., Speirs, K., Riera, K., & Grutzmacher, S. (2015). More than Just Not Enough: Experiences of Food Insecurity for Latino Immigrants. Journal of Immigrant and Minority Health, 17(5). doi:10.1007/s10903-014-0124-6
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  Undocumented Latino immigrants often struggle to provide food for their families. In an attempt to inform efforts to create effective programs and policies promoting food security, this study explored the experience of food insecurity for low-income, undocumented Latino immigrants. In-depth qualitative interviews were conducted with 24 undocumented Latino immigrants. Modified grounded theory was used to analyze the interview data. The experience of food insecurity was similar to other groups’ experiences, as it entailed inadequate amount and quality of food. However, immigration and documentation status presented unique vulnerabilities for food insecurity related to unfamiliar food environments, remittances and separation, employment, and community and government resources. Cultural and structural factors that may shape the experience of and response to food insecurity are discussed along with implications for policy and programming.
• Wilcox, C., Grutzmacher, S., Ramsing, R., Rockler, A., Balch, C., Safi, M., & Hanson, J. (2015). From the field: Empowering women to improve family food security in Afghanistan. Renewable Agriculture and Food Systems, 30(1). doi:10.1017/S1742170514000209
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  Kitchen gardens may improve family food security and nutrition. While these gardens are the domain of women in Afghanistan, women face unique challenges accessing training and resources to maximize small-scale agricultural output. The University of Maryland's Women in Agriculture Project builds capacity among female extension educators to work with vulnerable women to implement and maintain kitchen gardens. Extension educators use experiential methods to teach vegetable gardening, apiculture, small-scale poultry production, post-harvest handling and processing, nutrition and marketing through workshops, demonstration gardens and farmer field schools. This paper explores contextual factors related to women's food security and agricultural opportunities, describes key project activities and approaches and discusses project success and challenges, sustainability and implications for future programs.
• Song, H. J., Grutzmacher, S. K., & Kostenko, J. (2014). Personal weight status classification and health literacy among Supplemental Nutrition Assistance Program (SNAP) participants. Journal of community health, 39(3), 446-53.
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  The purpose of this study was to examine the conceptual gap between self-perceived weight and body mass index (BMI), and to assess the knowledge gap between perceived importance of following dietary guidelines and health literacy levels. Adults (n = 131) eligible for the Supplemental Nutrition Assistance Program (SNAP) were interviewed at eleven SNAP regional offices in Maryland. Based on BMI calculated from self-reported height and weight, 65.6% of participants were overweight or obese while 40.5% perceived that they were overweight or obese. In sub-group analysis categorized by BMI, only 20.0% in the overweight and 20.0% in the obese group correctly perceived themselves as being overweight or obese. Following dietary guidelines was perceived as important by a majority of participants, but only 43.5% had adequate health literacy. Conceptual and knowledge gaps between self-perception and objective health status existed in the low-income SNAP-eligible sample. Future studies need to address these gaps because misperceived weight status and insufficient health literacy are critical barriers to inducing behavioral change.
• Song, H., Grutzmacher, S., & Kostenko, J. (2014). Personal weight status classification and health literacy among supplemental nutrition assistance program (SNAP) participants. Journal of Community Health, 39(3). doi:10.1007/s10900-013-9796-4
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  The purpose of this study was to examine the conceptual gap between self-perceived weight and body mass index (BMI), and to assess the knowledge gap between perceived importance of following dietary guidelines and health literacy levels. Adults (n = 131) eligible for the Supplemental Nutrition Assistance Program (SNAP) were interviewed at eleven SNAP regional offices in Maryland. Based on BMI calculated from self-reported height and weight, 65.6 % of participants were overweight or obese while 40.5 % perceived that they were overweight or obese. In sub-group analysis categorized by BMI, only 20.0 % in the overweight and 20.0 % in the obese group correctly perceived themselves as being overweight or obese. Following dietary guidelines was perceived as important by a majority of participants, but only 43.5 % had adequate health literacy. Conceptual and knowledge gaps between self-perception and objective health status existed in the low-income SNAP-eligible sample. Future studies need to address these gaps because misperceived weight status and insufficient health literacy are critical barriers to inducing behavioral change. © 2013 Springer Science+Business Media New York.
• Speirs, K. E., Messina, L. A., Munger, A. L., & Grutzmacher, S. K. (2012). Health literacy and nutrition behaviors among low-income adults. Journal of health care for the poor and underserved, 23(3), 1082-91.
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  The purpose of this study was to explore the relationship between health literacy and nutrition behaviors using a low-income sample. Face-to-face surveys at 11 social services offices generated a convenience sample of 154 Supplemental Nutrition Assistance Program (SNAP)-eligible adults. We assessed health literacy, fruit and vegetable intake, food label use, consumption of healthy foods, and demographic characteristics. Thirty seven percent of the sample had adequate health literacy as measured by the Newest Vital Sign (NVS). Race and parenthood were significantly related to health literacy scores. Adequate health literacy, as measured by the NVS, was associated with frying chicken less often and eating the peels of fresh fruit more often. The findings suggest that health practitioners should ensure nutrition-related messages are accessible to all of their clients, especially those with the lowest health literacy levels.
• Speirs, K., Messina, L., Munger, A., & Grutzmacher, S. (2012). Health literacy and nutrition behaviors among low-income adults. Journal of Health Care for the Poor and Underserved, 23(3). doi:10.1353/hpu.2012.0113
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  The purpose of this study was to explore the relationship between health literacy and nutrition behaviors using a low-income sample. Face-to-face surveys at 11 social services offices generated a convenience sample of 154 Supplemental Nutrition Assistance Program (SNAP)-eligible adults. We assessed health literacy, fruit and vegetable intake, food label use, consumption of healthy foods, and demographic characteristics. Thirty seven percent of the sample had adequate health literacy as measured by the Newest Vital Sign (NVS). Race and parenthood were significantly related to health literacy scores. Adequate health literacy, as measured by the NVS, was associated with frying chicken less often and eating the peels of fresh fruit more often. The findings suggest that health practitioners should ensure nutrition-related messages are accessible to all of their clients, especially those with the lowest health literacy levels. © Meharry Medical College.
• Grutzmacher, S., & Gross, S. (2011). Household food security and fruit and vegetable intake among low-income fourth-graders. Journal of Nutrition Education and Behavior, 43(6). doi:10.1016/j.jneb.2010.10.004
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  To examine the relationship between household food security and children's and parents' fruit, vegetable, and breakfast consumption and fruit and vegetable availability. Design: Cross-sectional study using matched parent-child surveys. Setting: Title I elementary schools in Maryland. Participants: Ninety-two low-income parent-child dyads recruited from fourth-grade nutrition education programs completing a baseline evaluation. Main Outcome Measures: Fruit and vegetable intake, breakfast consumption, and fruit and vegetable availability in home and school. Analysis: Chi-square tests, 1-way ANOVA. Results: Thirty-six percent of parents reported low/very low household food security, and both parents and students reported low fruit and vegetable intake. Students from households with low food security who were not participating in school nutrition programs had the lowest vegetable consumption and the fewest number of days consuming breakfast, indicating a relatively greater need for enrollment than their peers. Conclusions and Implications: Few differences between children in food-secure and food-insecure households were observed, which underscores the need for research on food insecurity and children's eating behaviors. Examination of other factors influencing fruit and vegetable intake and improvements in food environments and programs are needed. Efforts to increase enrollment among eligible students in school nutrition programs may reduce negative consequences of household food insecurity. © 2011 Society for Nutrition Education and Behavior.
• Grutzmacher, S., & Gross, S. (2011). Household food security and fruit and vegetable intake among low-income fourth-graders. Journal of nutrition education and behavior, 43(6), 455-63.
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  To examine the relationship between household food security and children's and parents' fruit, vegetable, and breakfast consumption and fruit and vegetable availability.
• Grutzmacher, S., & Braun, B. (2008). Food security status and food resource management skills over time among rural, low-income mothers. Journal of Hunger and Environmental Nutrition, 2(2-3). doi:10.1080/19320240801891487
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  This study examined changes in food security status over time in a sample of rural, low-income mothers. Independent samples t-tests determined differences between food-secure and food-insecure mothers on variables such as employment status, food resource management skills, food assistance, and economic well-being at 3 points in time. Findings indicate that mothers in food-secure households were significantly more likely to possess food resource management skills than mothers in food-insecure households in the first wave of data, but that this relationship was not found when examined in the second and third waves. Findings emphasize the need for further research and testing with nutrition education programs to identify the extent to which skills and resources protect rural, low-income families from food insecurity. © 2007 by The Haworth Press, Inc.